Monitoring coronary heart disease worldwide

Coronary heart disease accounts for an estimated five million deaths a year worldwide. Not only is it the leading cause of death in Western industrialised countries; it is an increasingly important problem in developing countries.1 The potential for prevention has long been recognised because of the widespread geographical differences in the incidence of the disease and the dramatic improvements in mortality that have occurred in many countries since the late 1960s.2 Still to be resolved are the reasons for the decline in mortality from both coronary heart disease and stroke in many countries and the continuing increase in countries of eastern and central Europe.

In the late 1970s it was realised that more data were needed to explain why death rates were changing than were provided in routine death certificates.3 Validated data from death certificates and complementary data on non-fatal myocardial infarctions, stroke, acute coronary care, and standard risk factors were essential. On the basis of the experience gained from the registers of ischaemic heart disease and stroke of the 1970s,4 the MONICA project was conceived in the early 1980s to MONItor the trends in and determinants of cardiovascular diseases. It was …